Legal and human rights issues in the use of electronic monitoring (using GPS 'tracking' technology) in forensic mental health settings in the UK.

Electronic monitoring (EM) of individuals has been used by the criminal justice system for the past thirty years, and in the UK, use is on the increase. Its use has been justified as an alternative to prison to reduce recidivism and allowing early release of prisoners, however, the evidence base for this remains mixed. In 2010, it was employed for the first time in a forensic psychiatry setting. A study investigating the effects of EM on leave episodes concluded that EM may improve the speed of patient progress and reduce the length of admission, leading to reduced costs and increased public safety. However, the intervention generated considerable controversy and sparked discussion about ethical concerns. Here, we consider specifically legal and human rights issues that emerge from use of EM in forensic healthcare settings, scrutinising its use in the context of the Mental Health Act and the Human Rights Act. We conclude that EM is legal and justifiable, providing it is used judiciously and with due consideration of concerns for the individual and the given context.

Mental health care for foreign national prisoners in England and Wales.

BACKGROUND: The foreign national prisoner (FNP) population in England and Wales has disproportionately increased in size, but mental health research in this group has been limited. AIMS: Define the FNP group, review their understood characteristics, identify service challenges and make onward recommendations. METHODS: A literature search of Pubmed and Google Scholar was undertaken. Relevant articles/reports were identified and reviewed. RESULTS: Many FNPs face challenges: isolation (with limited family contacts); language barriers; difficulties accessing services; prejudice and discrimination; active legal issues regarding immigration. These are compounded by poor quality interpreting services, institutional barriers including racial assumptions propagated by forces of legislation, the disrupted local care pathways and common mental health problems (including post-traumatic stress disorder, depression and anxiety). Pre-detention trauma, self-harm and suicide are over-represented. CONCLUSIONS: Further prevalence and unmet needs research is urgently required. A validated screening tool could assist identification and service access for FNPs with mental health problems. Services providing relatively inexpensive interventions specific to the needs of FNPs (e.g. narrative exposure therapy) should be piloted.

Variations in prison mental health services in England and Wales.

In responding to high levels of psychiatric morbidity amongst prisoners and recognising earlier poor quality prison mental health care, prison mental health in-reach teams have been established in England and Wales over the last decade. They are mostly provided by the National Health Service (NHS), which provides the majority of UK healthcare services. Over the same period, the prison population has grown to record levels, such that prisons in England and Wales now contain almost 90,000 of the world's overall prison population of over 10 million people (roughly the size of Paris or Istanbul). This study provides an overview of mental health in-reach services in prisons in England and Wales, including variations between them, through a telephone survey of senior staff in all prisons and young offender institutions in England and Wales. 73% of prisons took part; of them 13% had no in-reach team at all (usually low security establishments) and the majority of services were run by NHS teams, usually according to a generic community mental health team (CMHT) model rather than other specialist models. Team size was unrelated to prison size. Each nurse covered around 500 prisoners, each doctor over 3700. Many provided few or no healthcare cells and 24-h psychiatric cover (including on-call cover) was uncommon. Despite developments in recent years, mental health in-reach services still fall short of community equivalence and there is wide variation in service arrangements that cannot be explained by prison size or function. The aim of community equivalence has not yet been reached in prison healthcare and a more sophisticated measure of service improvement and standardisation would now be useful to drive and monitor future development.

Asserting prisoners' right to health: progressing beyond equivalence.

The concept of the "right to health," regardless of a person's legal status, is a guiding force in establishing adequate standards of health care for all, including prisoners with mental illness. Prison health care in the United States, however, often falls below acceptable minimum standards. In the United Kingdom, the notion of equivalence has been the main driving force in improving prison mental health care. Although improvements have been made over the past ten years, demand for services continues to outstrip supply, as in the U.S. prison system. In both prison systems, prisoners often present with complex and multiple needs, much greater than those found in community samples. Even mental health care equivalent to that provided in the community falls significantly short of what is required. Further improvements to prison health care, therefore, remain a priority, and a more suitable model needs to be established and implemented. The authors propose an assertive application of a person's right to health with a well-defined framework for health care that is available, accessible, acceptable, and of good quality (AAAQ). The authors explore how the AAAQ framework can move beyond minimal or equivalent standards to deal with complex prison structures, meet health care needs, and measure progress more effectively. The AAAQ framework could lead to more equitable standards of health care that can be applied to international settings.